f.nunnariTCM: October 29, 2019, 1:16am
Would appreciate feedback on my assessment so far, I have supplemented the Si , liver and Lu, I had considered to
SUPP the UB at one stage but thought it may be too harsh…and it wasn’t until I wrote up the case in this format
that I realised how prominent the heart XS may be…
Female: 30 yo, primary school teacher
Chief complaint:
Facial Acne – Red pimples, raised and scarring.+9 past 15 years, onset at puberty, settled in early 20’s, flared up
past few years.
2nd complaint:
-Short cycle (alternate between 23 and 25 days) +3
-hormones- pre period: swelling of face, fluid retention, gas and bloating +3
Worse with:
-dairy
flared up after coming off the pill (had no period for 5 years, while on the pill)
Better with:
eliminating dairy, sugar, caffeine
has improved with herbal treatment, cycle has lengthened to 27days, with minimal premenstrual symptoms.
Appearance/demeanour:
-bright and happy demeanour +8
acne is covered over with makeup
bright eyes +7
Lifestyle:
teacher
doesn’t drink/smoke/party
-beach clean-ups/involved with community environmental groups.
Body morphology, flesh quality:
medium build, tall
currently body has healthy flesh quality (has improved since treatment- herbs and acupuncture, less fluid
retention, but acne on face persistent, red, inflamed
Skin quality:16/01/2024, 12:15Acne case – possibly Heart Excess – Qiological Community
https://forum.qiological.com/t/acne-case-possibly-heart-excess/711/print2/9
moist, sweats easily (dripping sweat, if gets nervous or overheated +8
-acne on cheeks, jawline, +9
Body temp:
aversion to heat, +7 runs hot, but cold feet to palpate.
GI:
improved since treatment, less gas, +2 regular BM
BM:better, but tendency to get sluggish +5
Thirst: has thirst, drinks lots of water +7
Respiratory:
Sleep:
-solid sleeper
Emotions:
-happy +8, polite +8, friendly+8
-perhaps a tendency to anxiety +5
Urination:
Gyny:
high testosterone
short menstrual cycle (21-25days)
Other?
Pain:
tight neck and shoulders +4 – sees a chiro regularly
Exs presentations:
Heart:
-warm abdomen/midline
-loving – cares for the environment
-teacher – takes care of children
-runs hot
-thirst
UB:
-thirst?
Gb:
Acne location – jaw line, tendency to clench jaw at night.16/01/2024, 12:15Acne case – possibly Heart Excess – Qiological Community
https://forum.qiological.com/t/acne-case-possibly-heart-excess/711/print3/9
Pc:
-intellectual … inquisitive – asks lot of questions in treatment to try and understand what is going on to gain a
better understanding
Sj:
-hot body…cold feet?
-bright eyes
Liv:
-cold feet?
-short menstrual cycle?
St:
-digestive issues
-acne (location – jaw line, chin, cheeks, neck)
Li:
-digestive issues?
Sp:
-digestive issues?
-moist skin/sweaty/slight smell to skin
-dripping sweat when nervous? Or more a heart exs?
Si:
Kid:
-symmetry
-cares about looks?
The GROSSEST:
-red acne on face
-wet skin/sweats easily
-polite and friendly
Main ideas:
Supplement: UB SI, Liv, Lung
f.nunnariTCM: October 29, 2019, 1:18am
16/01/2024, 12:15Acne case – possibly Heart Excess – Qiological Community
https://forum.qiological.com/t/acne-case-possibly-heart-excess/711/print4/916/01/2024, 12:15Acne case – possibly Heart Excess – Qiological Community
https://forum.qiological.com/t/acne-case-possibly-heart-excess/711/print5/9
KristinWisgirda: October 29, 2019, 6:56pm
Thanks for the case.
f.nunnariTCM:
it wasn’t until I wrote up the case in this format that I realised how prominent the heart XS may be…
Putting it all down on paper can really help. The pictures really shows the full face redness of H excess
extending down into her neck. To your list of H excess symptoms, you can add
f.nunnariTCM:
tight neck
assuming the tension is on the UB channel.
So we know she is really hot. I am curious about the damp/dry balance. Thirst can be internal
(stomach)/external(mouth) dryness. If she was thirsty for cold particularly then it would support the Heart excess16/01/2024, 12:15Acne case – possibly Heart Excess – Qiological Community
https://forum.qiological.com/t/acne-case-possibly-heart-excess/711/print6/9
diagnosis. The dripping sweat is definitely dampness in the exterior, whether or not it is tied to heat or nervousness.
From the pictures her flesh looks soft, even though you say
f.nunnariTCM:
currently body has healthy flesh quality
If the flesh is still soft, you can call this interior damp. Symptoms (acne?, menses?) are worse with dairy which is a
damp substance. It is hard to see how greasy the skin on her face is, but there are pustules. There seems to be a case
to be made for double damp Spleen excess. The damp could definitely be trapping heat and making the heat signs
worse.
A couple of notes of your analysis of symptoms:
“Digestive issues” isn’t really diagnostic of anything in particular for Saam. Excess of any of the 12 channels could
contribute to digestive problems of some kind. The quality of the digestive issues would be more informative-
dryness, lack of descent, bloating, poor appetite, etc.
If a channel has changes, note it under the channel excess and the counterbalancer. So acne in the GB channel, can
also go under P excess too, etc. With all of the channels in her face being involved, knowing which channels in her
neck and shoulders have compromised circulation leading to tension might be interesting.If the patient is vague,
palpating the area can be informative.
The pms signs (blood build up) can also go under Kidney excess, even if they are only mild now. Any varicosities
or blood stasis signs to build more of an arguement for K excess?
Until we have attained the level of practice of Toby’s teacher, we have to rely on gathering as many details as
possible to really see our patient.
Jeffrey: October 29, 2019, 7:53pm
@f.nunnariTCM fun case to treat with Saam.
@KristinWisgirda is of course a wealth of knowledge and our best bet to go on.
From your description, the loudest thing in the room for me as an additional set of eyes are;
warm to hot with cool -cold feet
bright eyes
polite
anxiety
etc., all SJ xs
so LV+ may really be in the game here
f.nunnariTCM: October 30, 2019, 12:53am
16/01/2024, 12:15Acne case – possibly Heart Excess – Qiological Community
https://forum.qiological.com/t/acne-case-possibly-heart-excess/711/print7/9
Yes good point, the neck tension is not something she has complained about to me, but I have felt upon palpating,
it is more on the Right, neck (UB channel), upper trap (GB), and especially scalenes (ST), all on the right side.
f.nunnariTCM: October 30, 2019, 1:04am
The flesh on the body is different to the face/neck, more healthy, not too soft not too firm, it has improved since
treatment before Saam, but there is a tendency to fluid retention of the whole body which can be a bit puffy.
But there is definitely a “damp” sticky quality to the skin, more so the extremities.
f.nunnariTCM: October 30, 2019, 1:17am
Thank you for the feedback Kristin, much appreciated.
By “digestive issues” I was summarising the issues I mentioned earlier in the case, but perhaps not so clear – gas
and bloating especially if eats onions, pulses, and before period, tendency towards a more dry stool or incomplete
stool, but I didn’t know how to put these as they have improved to not much of an issue since herbs and
acupuncture prior to SA’AM, there is still a “tendency” To occur but as a “one off”.
f.nunnariTCM: October 30, 2019, 1:30am
Thanks Jeffrey,
I have supplemented her Liver, and it definitely helped with the mild anxiety and sleep, maybe some mild
improvement with her skin, and tension in shoulders.
Overall, in summary all symptoms have improved but the skin is most outstanding.
I forgot to mention she has very tender breasts pre menstrually, which would also be SJ xs? May also be St, Ht, Pc?
f.nunnariTCM: October 30, 2019, 1:36am
Yes I am struggling with obtaining enough detail…or asking the right questions… I have been using a pulse based
system prior to Saam, which uses minimal and very specific questioning, so having to switch my brain to a
different way of viewing and questioning the patient.
Jeffrey: October 30, 2019, 1:58pm
f.nunnariTCM:16/01/2024, 12:15Acne case – possibly Heart Excess – Qiological Community
https://forum.qiological.com/t/acne-case-possibly-heart-excess/711/print8/9
I forgot to mention she has very tender breasts pre menstrually, which would also be SJ xs? May also be St, Ht,
Pc?
Certainlty ST would be the channel, and you have you have used Lu+, so that may be a consideration at some point
again. Agreed that more questioning will help here. Does her pre-menses breast tenderness cause irritability?
Sometimes GB xs seems to exist un patients yet not easy to nail down. Interested in how this goes, good luck
KristinWisgirda: October 30, 2019, 3:29pm
@Jeffrey for sure there is SJ excess.
The loudest thing in the room for me is the full face redness spreading into her neck- clear Heart excess! Since
there are so many signs to confirm that and that the acne is her chief complaint, UB+ is my first choice.
f.nunnariTCM:
The flesh on the body is different to the face/neck, more healthy, not too soft not too firm, it has improved
since treatment before Saam, but there is a tendency to fluid retention of the whole body which can be a bit
puffy.
But there is definitely a “damp” sticky quality to the skin, more so the extremitie
This clarifying information makes LI+ a close second for me.
For the GI symptoms, I just wanted to caution that generalized GI problems aren’t “for sure” signs of anything in
Saam.
f.nunnariTCM:
so having to switch my brain to a different way of viewing and questioning the patient.
Saam has the same nuts and bolts as other TEAM traditions, just organized in a different way. Cases studies are a
great tool for practicing your Saam thinking and observation.
Jeffrey: October 30, 2019, 5:02pm
KristinWisgirda:
The loudest thing in the room for me is the full face redness spreading into her neck-16/01/2024, 12:15Acne case – possibly Heart Excess – Qiological Community
https://forum.qiological.com/t/acne-case-possibly-heart-excess/711/print9/9
Agreed! … sorry, I meant after your suggestion
Of the above.
f.nunnariTCM: November 1, 2019, 3:32am
Great, thank you both so much for the feedback, much appreciated.
f.nunnariTCM: November 6, 2019, 1:14am
So to update this case, I had treated her with Liv+ just before I posted this case, was planning on UB+ or Li+ after
this discussion, but she postponed her appointment to next week as she took the day off to have with friends up
North… her wording was she hasn’t been in a good headspace and doesn’t find joy in the things she used to, and
spending time with friends might help. I wasn’t expecting this, she has alway been very positive and happy…
judging from this I’m assuming Liv+ was not correct? but maybe I’ll have a better understanding once I see her.